Provider Demographics
NPI:1811449234
Name:KONE, ISSOUF (PHARMD)
Entity type:Individual
Prefix:
First Name:ISSOUF
Middle Name:
Last Name:KONE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 S GILBERT RD
Mailing Address - Street 2:APT # 1028
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-8031
Mailing Address - Country:US
Mailing Address - Phone:216-298-3701
Mailing Address - Fax:
Practice Address - Street 1:5330 E WASHINGTON ST
Practice Address - Street 2:SUITE D-105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2140
Practice Address - Country:US
Practice Address - Phone:602-732-3384
Practice Address - Fax:602-732-3394
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022246183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist